Medical Equipment Loan Agreement

Date:
Lender:
Address of Lender:
Borrower:
Address of Borrower:

1. Equipment Details

Name/Description Serial/ID Number Condition Accessories Included

2. Loan Period

Start Date:
End Date:

3. Terms & Conditions

  1. The equipment must be returned in the same condition as received, subject to reasonable wear and tear.
  2. The borrower is responsible for the loss or damage of the equipment during the loan period.
  3. The equipment is to be used only for its intended medical purpose.
  4. Any maintenance, repair, or servicing required due to improper use will be the responsibility of the borrower.
  5. Extension of the loan period must be agreed upon in writing by both parties.

4. Additional Notes

Lender Signature:
Date:
Borrower Signature:
Date: